scholarly journals The Underutilization, Adverse Reactions and Efficacy of Statins after Liver Transplant: A Meta-Analysis and Systematic Review

2021 ◽  
Vol 2 (3) ◽  
pp. 264-273
Author(s):  
Yeung Jek Ho ◽  
Audrey Su-Min Koh ◽  
Zhi Hao Ong ◽  
Cheng Han Ng ◽  
Gwyneth Kong ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Statin Therapy ◽  
Adverse Reactions ◽  
Meta Analysis ◽  
Mortality Benefit ◽  
Future Studies ◽  
The Impact ◽  
Embase Database ◽  
Hcc Recurrence ◽  
Significant Mortality

(1) Background: Treatment of dyslipidemia via statin therapy in the non-liver transplant (LT) population is associated with a mortality benefit; however, the impact of statin therapy in post-LT population is not well-defined. This meta-analysis seeks to investigate the safety and efficacy of statin therapy in post-LT patients. (2) Methods: A systematic literature search on Medline and EMBASE database was conducted. A single-arm proportional meta-analysis and conventional pair-wise meta-analysis were performed to compare different outcomes with a random effects model. (3) Results: A total of 11 studies were included in this study, with 697 LT recipients identified to be on statin therapy. Statins were underutilized with only 32% (95% CI: 0.15–0.52) of 1094 post-LT patients on therapy. The incidence of adverse events of 14% (95% CI: 0.05–0.25) related to statin therapy was low. A significant mortality benefit was noted in patients on statin therapy with HR = 0.282 (95% CI: 0.154–0.517, p < 0.001), and improved lipid profiles post LT. The use of statins also significantly decreased odds of graft rejection (OR = 0.33; 95% CI: 0.15–0.73) and hepatocellular carcinoma (HCC) recurrence (HR = 0.32, 95% CI: 0.11–0.89). (4) Conclusions: Statin therapy is safe and efficacious in post-LT patients. Future studies to evaluate the effects of interactions between statins and immunosuppressant therapy are warranted.

The impact of obesity on patient survival in liver transplant recipients: a meta-analysis

2014 ◽  
Vol 35 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Sammy Saab ◽  
David Lalezari ◽  
Paridhima Pruthi ◽  
Theodore Alper ◽  
Myron J. Tong
Keyword(s):  
Liver Transplant ◽  
Patient Survival ◽  
Meta Analysis ◽  
Transplant Recipients ◽  
Liver Transplant Recipients ◽  
The Impact

Abstract 16432: Optimal Dosing of ACE Inhibitors and ARBs in Chronic Heart Failure Patients - A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Aaqib H Malik ◽  
Yasir Akram ◽  
Senada S Malik
Keyword(s):  
Heart Failure ◽  
Ace Inhibitors ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Mortality Benefit ◽  
Heart Failure Patients ◽  
Randomized Controlled ◽  
Optimal Dosing ◽  
Significant Mortality

Introduction: Congestive heart failure (CHF) is associated with significant morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are proven to be beneficial for improved survival and better quality of life in Heart failure patients. Optimal dosing of these agents presents a challenging question till date and controversy still surrounds whether similar health benefits can be achieved through lower dosages of ACE inhibitors and ARBs. Our aim was to determine whether there is a significant mortality benefit in CHF patients who receive higher dosage of ACE inhibitors and ARBs compared to lower dosage. Methods: Medline Indexed and Non-indexed, Cochrane Central, CINAHL and PsychINFO were searched for randomized controlled trials (RCTs) published till date. All RCTs that compared the clinical impact of high versus low dosage of ACE inhibitors or ARBs in heart failure patients were identified. Two independent investigators assessed the studies against an a priori inclusion criteria and disagreements were resolved by mutual discussion. Results: We used reported event rates for all studies to compute cumulative odds ratio and p-value for mortality. Summary effects were estimated using random effects models in RevMan 5.2. Of 1610 potentially relevant studies, a total of 5 studies (9027 patients) met our inclusion criteria and had data available on mortality events. The pooled estimate of the included studies showed a statistically significant 10% reduction in mortality of CHF patients who received higher dosage of ACE inhibitor and ARBs. (Odds Ratio: 0.90; 95% confidence interval 0.82,0.99). Heterogeneity was tested and it showed no evidence of publication bias. Conclusions: In conclusion, our meta-analysis of RCTs shows that higher dosage of ACE inhibitors and ARBs have a clinically and statistically significant mortality benefit over lower dosage in the management of chronic heart failure patients.

scholarly journals De Novo Donor Specific Antibody and Long-Term Outcome After Liver Transplantation: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 11 ◽  
Author(s):  
Zahra Beyzaei ◽  
Bita Geramizadeh ◽  
Zahra Bagheri ◽  
Sara Karimzadeh ◽  
Alireza Shojazadeh
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
De Novo ◽  
Meta Analysis ◽  
Graft Loss ◽  
Cochrane Library ◽  
Long Term Outcome ◽  
The Impact

BackgroundThe impact of de novo anti-HLA donor-specific alloantibodies (DSA) which develop after long-term liver transplantation (LT) remains controversial and unclear. The aim of this study was to investigate the role of de novo DSAs on the outcome in LT.MethodsWe did a systematic review and meta-analysis of observational studies published until Dec 31, 2019, that reported de novo DSA outcome data (≥1 year of follow-up) after liver transplant. A literature search in the MEDLINE/PubMed, EMBASE, Cochrane Library, Scopus and Web of Science Core Collection databases was performed.ResultsOf 5,325 studies identified, 15 fulfilled our inclusion criteria. The studies which reported 2016 liver transplant recipients with de novo DSAs showed an increased complication risk, i.e. graft loss and chronic rejection (OR 3.61; 95% CI 1.94–6.71, P &lt; 0.001; I2 58.19%), and allograft rejection alone (OR 6.43; 95% CI: 3.17–13.04; P &lt; 0.001; I2 49.77%); they were compared to patients without de novo DSAs. The association between de novo DSAs and overall outcome failure was consistent across all subgroups and sensitivity analysis.ConclusionsOur study suggested that de novo DSAs had a significant deleterious impact on the liver transplant risk of rejection. The routine detection of de novo DSAs may be beneficial as noninvasive biomarker-guided risk stratification.

scholarly journals Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-analysis

2015 ◽  
Vol 47 (1) ◽  
pp. 133-146 ◽  
Author(s):  
Kim F.E. van de Loo ◽  
Marleen M.H.J. van Gelder ◽  
Jolt Roukema ◽  
Nel Roeleveld ◽  
Peter J.F.M. Merkus ◽  
...  
Keyword(s):  
Psychological Stress ◽  
Observational Studies ◽  
Data Extraction ◽  
Meta Analysis ◽  
Subsequent Development ◽  
Respiratory Morbidity ◽  
Stress Exposure ◽  
Future Studies ◽  
Meta Analyses ◽  
The Impact

The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood.All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed.The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36–1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing.This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress.

scholarly journals A Meta-Analysis on the Rate of Hepatocellular Carcinoma Recurrence after Liver Transplant and Associations to Etiology, Alpha-Fetoprotein, Income and Ethnicity

2021 ◽  
Vol 10 (2) ◽  
pp. 238
Author(s):  
Darren J. H. Tan ◽  
Chloe Wong ◽  
Cheng Han Ng ◽  
Chen Wei Poh ◽  
Sneha Rajiv Jain ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplant ◽  
Latin American ◽  
Economic Status ◽  
Meta Analysis ◽  
Deceased Donor ◽  
Alpha Fetoprotein ◽  
Milan Criteria ◽  
Asian Populations ◽  
Hcc Recurrence

Hepatocellular carcinoma (HCC) recurrence after liver transplant is associated with a poor prognosis and significantly increases morbidity and mortality among liver transplant patients. Therefore, this meta-analysis aims to evaluate the overall prevalence of HCC recurrence following liver transplant. Medline and Embase databases were searched, and a meta-analysis of proportions was conducted. Observational studies reporting the prevalence of recurrent hepatocellular carcinoma (HCC) after liver transplant were included, with the analysis being stratified by adherence to Milan criteria, ethnicity, socio-economic status, alpha fetoprotein (AFP) levels, living donor vs. deceased donor, and the underlying aetiology of the liver disease. A meta-regression on the date of the study completion was also performed. Of a total 40,495 patients, 3888 developed an HCC recurrence. The overall prevalence of recurrent HCC was 13% (CI: 0.12–0.15). Patients beyond the Milan criteria (MC) were more likely to recur than patients within MC. Asian populations had the greatest prevalence of HCC recurrence (19%; CI: 0.15–0.24) when compared to Western (12%; CI: 0.11–0.13) and Latin American populations (11%; CI: 0.09–0.14). The prevalence of recurrent HCC was the highest in patients infected with hepatitis B virus (HBV) (18%; CI: 0.11–0.27) compared to other aetiologies. A higher AFP also resulted in an increased recurrence. This highlights interesting differences based on ethnicity, income, and aetiology, and further studies are needed to determine the reasons for the disparity.

The impact of statin therapy on plasma levels of von Willebrand factor antigen

2016 ◽  
Vol 115 (03) ◽  
pp. 520-532 ◽  
Author(s):  
Amirhossein Sahebkar ◽  
Corina Serban ◽  
Sorin Ursoniu ◽  
Dimitri P. Mikhailidis ◽  
Anetta Undas ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Von Willebrand Factor ◽  
Plasma Levels ◽  
Meta Analysis ◽  
Random Effect ◽  
Von Willebrand Factor Antigen ◽  
Von Willebrand ◽  
The Impact ◽  
Willebrand Factor ◽  
Factor Antigen

SummaryIncreased plasma levels of von Willebrand factor antigen (vWF:Ag) are associated with high risk of coronary artery disease. The effect of statin therapy on vWF:Ag levels remains uncertain. Therefore the aim of this meta-analysis was to evaluate the effect of statin therapy on vWF:Ag Levels. A systematic multiple-database search was carried out to identify randomized controlled trials (RCTs) that investigated the effect of statins on plasma vWF:Ag levels. Random-effect meta-analysis of 21 treatment arms revealed a significant decrease in plasma vWF:Ag levels following statin therapy (SMD: −0.54, 95 %CI: −0.87, −0.21, p=0.001). In subgroup analyses, the greatest effect was observed with simvastatin (SMD: −1.54, 95 %CI: −2.92, −0.17, p=0.028) and pravastatin (SMD: −0.61, 95 %CI: −1.18, −0.04, p=0.035), but not with fluvastatin (SMD: −0.34, 95 %CI: −0.69, 0.02, p=0.065), atorvastatin (SMD: −0.23, 95 %CI: −0.57, 0.11, p=0.179) and rosuvastatin (SMD: −0.20, 95 %CI: −0.71, 0.30, p=0.431). The lowering effect of statins on plasma vWF:Ag levels was greater in the subset of studies lasting ≥ 12 weeks (SMD: −0.70, 95 %CI: −1.19, −0.22, p=0.005) compared with that of studies lasting > 12 weeks (SMD: −0.34, 95 %CI: −0.67, 0.003, p=0.052). Finally, low-intensity statin therapy was not associated with a significant reduction in vWF:Ag levels (SMD: −0.28, 95 %CI: −0.82, 0.27, p=0.320), but a significant effect was observed in high-intensity statin trials (SMD: −0.66, 95 %CI: −1.07, −0.24, p=0.002). This meta-analysis of available RCTs demonstrates a significant reduction in plasma vWF:Ag levels following statin therapy.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

scholarly journals The Strategy and Efficacy of Prophylaxis Against Hepatitis B Virus Recurrence After Liver Transplantation in the Era of High Potent Nucleos(t)ide Analogues: A Meta-Analysis

2020 ◽  
Author(s):  
Mingshu Li ◽  
Zhouhua Hou ◽  
Guozhu Yao ◽  
Deming Tan ◽  
Qian Lin
Keyword(s):  
Liver Transplantation ◽  
Hepatitis B ◽  
Recurrence Rate ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Long Term Outcome ◽  
Effect Model ◽  
The Impact ◽  
Hcc Recurrence ◽  
Related Mortality

Abstract Background: High potent nucleos(t)ide analogues (HP NAs) with or without hepatitis B immunoglobulin (HBIG) is the standard prophylactic therapy for avoiding the HBV recurrence after liver transplantation (LT). While the clinical impact of HP NAs-based prophylaxis has not been well documented, the optimal treatment strategy is currently debated. This meta-analysis aims to evaluate clinical outcome of LT recipients under HP NAs-based regimens and investigate different prophylaxis schemes. Methods: We followed PRISMA statement to conduct this study. Two reviewers independently searched relevant literature via PubMed, EMBAES, MEDLINE, Web of Science, and Google Scholar. Studies were included if they observed HBV recurrence under HP NAs-based regimens in patients who received HBV-related LT. Primary and secondary outcome were HBV recurrence, HCC recurrence, all-cause and HBV-recurrence related mortality. Incidence with 95% confidence intervals was aggregated and assess by fixed effect model/random effect model. Subgroup analysis was applied to examine the impact of different treatment strategies. Results: 26 studies (n=2374) were included, with a pooled HBV recurrence rate of 0.92% (95% CI 0.47%-1.48%). Studies with and without HBV viremia or HDV superinfected patients demonstrated comparable HBV recurrence (p=0.25, p=0.69). Recurrence rate under indefinite combination of HP NAs and HBIG was lower than that under HP NAs monotherapy (p=0.0003), and similar to that under NAs plus finite course of HBIG (p=0.53). Pooled HCC recurrence rate was 5.34% (95% CI 0.78%-12.48%). HBV-recurrence related mortality and all-cause mortality were 0.17% (95% CI 0.00%-1.51%) and 7.29% (95% CI 4.42%–10.71%) respectively. Conclusion: Our study suggests HP NAs-based regimens provide satisfactory HBV antiviral prophylaxis and improved long-term outcome for LT recipients. Finite combination of HP NAs and HBIG is an alternative to lifelong dual therapy.

scholarly journals Evaluation of the Nighttime Operation Impact on Liver Transplantation: A Meta-Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Ziteng Zhang ◽  
◽  
Xiaoliang Zha ◽  
Xian He ◽  
Mingbo Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Liver Transplant ◽  
Publication Bias ◽  
Organ Procurement ◽  
Meta Analysis ◽  
Current Evidence ◽  
Pubmed Database ◽  
Study Results ◽  
Significant Difference ◽  
The Impact

Background: Liver transplant is frequently performed at night due to the unpredictability of organ procurement and reduction of Cold Ischemia Time (CIT). Previous study reported a doubled mortality Hazard Ratio (HR) of early death and increased postoperative complications in nighttime liver transplant. This study aims to evaluate the impact of nighttime operation on patients’ survival and postoperative complications by using meta-analysis. Methods: We performed a systematic review of the PubMed database and identified five eligible studies. Three time points (30 days, 90 days and 1 year) were explored in patients’ survival by using pooled HR. Four types of postoperative complications (vascular, biliary tract, wound and primary graft non-function) were investigated by using pooled Odds Ratio (OR). Publication bias was also performed. Results: Our study results were contradicting with the previous report and yielded no significant difference with a HR=0.98 (95% CI=0.89-1.06) on 30 days, HR=1.12 (95% CI=0.89-1.35) on 90 days and HR=1.07 (95% CI=0.95-1.18) on 1 year in nighttime procedure. Consistent with the result of patients’ survival, no significant result was found in postoperative complications evaluation as well. None of the four complications demonstrated significant result. And we failed to detect any significant publication bias. Conclusions: Based on current evidence, nighttime liver transplantations do not degrade patients’ survival or increase postoperative complications risk compared with daytime operations.

Impact of Statin Therapy on Plasma MMP-3, MMP-9, and TIMP-1 Concentrations: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Angiology ◽  
2017 ◽  
Vol 68 (10) ◽  
pp. 850-862 ◽  
Author(s):  
Gianna Ferretti ◽  
Tiziana Bacchetti ◽  
Maciej Banach ◽  
Luis E. Simental-Mendía ◽  
Amirhossein Sahebkar
Keyword(s):  
Statin Therapy ◽  
Meta Analysis ◽  
Low Density Lipoprotein ◽  
Plasma Concentrations ◽  
Density Lipoprotein ◽  
Clinical Findings ◽  
Tissue Inhibitors Of Metalloproteinases ◽  
Low Density Lipoprotein Cholesterol ◽  
Cholesterol Levels ◽  
The Impact

Tissue inhibitors of metalloproteinases (TIMPs) and matrix metalloproteinases (MMPs) are associated with the development of atherosclerosis and cardiovascular disease. Statin therapy has been shown to modulate MMPs and TIMP-1 levels, but clinical findings have not been conclusive. This study aimed to systematically review the clinical findings on the impact of statin therapy on plasma MMP-9, MMP-3, and TIMP-1 levels and calculate an effect size for the mentioned effect through a meta-analysis of available data. A total of 10 eligible studies with 11 treatment arms were included in the meta-analysis. Statin therapy had no significant effect on plasma MMP-9 (standardized mean difference [SMD]: −0.23, 95% confidence interval [CI]: −0.69 to 0.24, P = .345) nor MMP-3 concentrations (SMD: −0.004, 95% CI: −0.60 to 0.59, P = .990). However, meta-analysis demonstrated that statin therapy significantly decreases plasma TIMP-1 levels (SMD: −0.30, 95% CI: −0.56 to −0.03, P = .029). Random-effects meta-regression indicated that neither treatment duration nor changes in low-density lipoprotein cholesterol levels are associated with changes in plasma MMP-9 levels following statin therapy. The results of the present meta-analysis suggested a significant reduction in plasma concentrations of TIMP-1, but not MMP-9 and MMP-3, following statin therapy.

Sign in / Sign up

Export Citation Format

Share Document